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PAR offers the SPECTRA Indices of Psychopathology, a hierarchical dimensional look at adult psychopathology. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect. Learn more at parinc.com/spectra.
Hey everyone. Here we are. Welcome back.
Today we’re talking about EHRs, more specifically, do you need an EHR?
Spoiler, yes, you absolutely do. But why?
Today, I am [00:01:00] talking through the pros and cons of using an Electronic Health Record or EHR. I know that there are some folks out there who are still using paper and pencil files and calendars, but I think now is the time to consider a more efficient and secure way to manage your practice. So if that is you, listen on for a discussion about EHRs.
All right, everyone, let’s dive right into it. Start with some basics. If you heard or read the title of this podcast and said, what is an EHR? You are not alone. It’s okay. We’re going to figure it out.
So what are we talking about? An EHR [00:02:00] or Electronic Health Record, also called an EMR, Electronic Medical Record. These are terms that generally describe software options that are almost always internet-based and accessible from any computer or tablet that helps you manage your practice.
The software options almost always include calendaring or scheduling capability. So you can Schedule your appointments on a digital calendar, a telehealth option to conduct your sessions over telehealth, either using an established platform like Zoom or their own proprietary platforms that are built into the software.
EHRs will include some means of taking session notes and prompting you to write session notes for each of your appointments even for testing. They will typically help [00:03:00] you submit insurance claims, do payment processing and accounting, and manage staff if you have a group practice. Some will add other bells and whistles that may or may not be relevant to your practice. But these are some of the core features of an EHR. And for most of us, these are the things that we need. We need something that will help us keep our calendar, keep track of appointments, write our notes, do the billing, and potentially do some telehealth.
Let’s first talk about why you would not want to use an EHR. These are some reasons that I have heard over the years from folks that I consult with, coupled with some of the things that I found on the internet.
Using an EHR would likely be a transition from your current system. And frankly, change is hard. Change is hard. I will not [00:04:00] argue with that. For many people, it is a general sense of change. We just don’t like to do things differently, but for a lot of folks I hear that it’s the process of moving records over that is most daunting. So if you think that you have a filing cabinet upon filing cabinet of paper records or a paper calendar, the idea of somehow getting all of those records into an EHR is like I said, quite daunting. And so, that can be a hurdle for folks to take the leap.
Some folks have a little bit of a fear of technology and under this heading, there are a number of specific fears that come up for folks. One is, is my data safe? Can I trust that it will be there next time I access it? Is it going to be hacked? [00:05:00] Is there going to be a data breach? What if the EHR goes down or goes out? How can I rely on it? People have general questions like what is, a lot of these EHRs will talk about being cloud-based. Well, what is the cloud? People don’t understand what the cloud is and what that means. Understandably, these are vague terms unless you are dialed into their meaning. So just a fear of technology can get in the way.
Cost is a concern for some folks. I hear a lot, oh, I can’t afford that, I’m just starting my practice; or why would I pay that much to do something that I can do on my own? We’ll talk about the cost and what I think are pretty rational justifications for the cost of an EHR.
And then finally, EHRs are not required by anyone at this point. The APA does not require that you use an EHR. And [00:06:00] so, there’s no real external force that’s mandating that anyone switch to an EHR, which is enough of a motivating factor to keep people from changing.
So these are just a few reasons that you would not use an EHR. Some folks will say, my practice is not big enough, or ‘I don’t need it.’ I’m only seeing a few clients. I don’t need that much technology. I’m not doing enough private practice work to care about an EHR. It’s simpler to keep track of things on paper.
And just to clarify, when I say keep track of things on paper, that does mean on paper. Like if you’re opening one of those day timers or whatever, like the planner books that have a calendar in them or taking notes [00:07:00] on paper on a notepad or a legal pad and storing that in a file folder in a cabinet, but I’m also saying on “paper’ to mean keeping your notes in a word document and saving it on your computer or keeping track of your client payments on an Excel spreadsheet. So, I’m also using that term to mean any disparate or disconnected digital tools that you’re using that you may have cobbled together to run your practice as well.
Okay. So let’s flip the script a little bit and talk about why you would want to use an EHR. I’m just taking each of those reasons that you wouldn’t, and I’m going to address each of those.
One, the transition can be tough. Well, here are some solutions. Most EHRs have [00:08:00] very robust onboarding and training via videos, articles, demos, and just ongoing support. They are well aware that making the leap to an EHR can be challenging and they will help you. You’re definitely not alone if you would like some help. I tell folks to rely on their EHR support staff heavily, especially when they’re onboarding.
You have to keep in mind too that many folks are not just going from paper to an EHR, but many folks switch EHRs. And so, the onboarding system is pretty robust to help folks understand and get up to speed on that particular EHR. So that’s one thing. They have fantastic training and onboarding for the most part to help you overcome that change [00:09:00] process.
Now, if you’re worried about what to do with your existing records, you have two options.
One is you can simply hang on to those paper records and keep them in the file cabinets. You don’t technically have to do anything. But many times you can just scan those records or better yet, hire someone to scan those records and just upload them to the patient’s file on the EHR. You do not have to go into the EHR and somehow duplicate all of your notes from past sessions or redo them or something like that. You can just upload the files into the EHR there and they’re stored there. And you can get rid of those paper files and save some money on storage.
The next reason is fear. Let’s tackle all these fears. There are a lot of fears around security. I’ll say this right from the get go that all of the reputable [00:10:00] EHRs are going to be very secure. Without getting into software nuances and getting into the weeds of Software security, I can say confidently that any good EHR will have both HIPAA compliance and payment processing compliance built in. The standards for both of those are quite high. And like I said, any good EHR will have those bases covered. So security is not necessarily something that you need to worry about with an EHR.
Now, hacking or cybersecurity is always a threat with anything on the internet these days. But again, our EHRs have very high security protocols to keep data safe. Oftentimes, even if there is a cybersecurity issue, the data that is accessed [00:11:00] does not always include 100% identifying information of your patients.
You can also get cybersecurity liability insurance. So it might run you for small practices, maybe a $100or $200 a year, larger practices, it could be more. I think ours is maybe $1000. So if you’re really concerned, you can always get cybersecurity liability insurance. But EHRs are going to be very secure and honestly, we are playing in such a small field that our EHRs are not going to be the target of hacks, most likely. Those cybersecurity folks or hackers are likely to go after larger medical record system, hospital systems, that kind of thing.
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All right, let’s get back to the podcast.[00:13:00] As far as the cloud. So what is the cloud? The cloud is just a reference to the internet and storage systems on the internet, and it’s very safe. So it’s very safe and it has redundant backup systems. What that means is it would essentially be like having 50 copies of your paper notes stored in different safes in different locations.
So that’s a huge component to keep in mind with the cloud that it seems vague. It’s hard to wrap your hands around. There’s no physical location you can go to or see your data, but it is quite redundant. A lot of these systems will use larger software platforms like Google’s platform or Amazon AWS. They are incredibly [00:14:00] secure and very redundant, like I said.
Now, as far as downtime or the software going down or crashing, this does happen. I’m not going to lie, but I think it is very rare. In the 12 years that I have used our EHR, which is TherapyNotes, I can think of maybe two outages that actually impacted my life and my practice. And in each of those cases, they lasted for less than 24 hours. The TherapyNotes team was right on top of it and they were able to fix things pretty quickly. So people get really upset when the software goes down and it’s very rare.
Let’s tackle cost. To me, the cost thing is a no brainer. If you are talking about return on investment and money well spent when you’re starting your practice, if I hear somebody [00:15:00] complaining about $50 a month for an EHR and saying they can’t afford it, then we’re having a really serious conversation about whether they should be in private practice and whether they have the wherewithal to manage finances in the private practice because the $50 that you will spend on an EHR, and it varies, of course, some are going to be $20 a month, some are going to be $100 a month, but $50 give or take, is what you can expect to pay to have access to an EHR.
So if you just think of it in terms of time saved, this basically means that an EHR would need to save you 15 to 30 minutes a month, depending on what your fee is. If your fee is $100 an hour, then it needs to save you about 30 minutes a month. If your fee is $200 an hour, it needs to save you about 15 minutes a month to pay you back for the [00:16:00] money that you’re spending. So just to be super explicit, that translates to about 30 to 60 seconds a day or 5 to 10 minutes a week.
Now, if you’re using a paper system or even a disjointed Digital system, I’m guessing that you spend that much time even just like printing paperwork for your clients or organizing your paper files or your digital files. So 5 to 10 minutes a week. That’s all it has to save you. And in my experience, it goes way beyond that.
The other component is many EHRs allow you to store a credit card in the system for your clients to pay with. And if you’re like many of us and sometimes have issues with clients paying their bill, this will greatly cut down on those unpaid bills.
So If you think about it, if you have [00:17:00] an individual who even just one person, one evaluation that went unpaid, but you were able to have a credit card stored on file that you could charge, that would essentially pay for 2 to 3 years of the EHR cost depending on how much you charge for the evaluation.
So for me, when people complain about cost, again, this is a complete no brainer. It’s the same as people asking whether they should have a Psychology Today profile which is $30 a month. The answer is 100% yes. The cost of this is not the issue and it’s going to save you way more time than it costs.
Okay. So to the last point, an EHR is not required. This is true, but honestly, at this point, why would you not use an EHR? We’ve talked about how it will save money. It can save time. It is more secure than paper files or a [00:18:00] calendar. You can access it anywhere that you have access to the internet and my last point is that it is future proof.
So unless you’re planning to retire in the next three years, five years maybe, and if you’re a private pay practitioner, this is going to be relevant for everyone else. So, if you take insurance and you plan to practice for at least 10 more years, we are definitely moving toward transparency with medical records and what we call interoperability. That means sharing records between healthcare providers.
Paper notes do not play well to either of those factors. So the open notes standard and the idea that patients are going to be able to access their notes is super important. You, I’m guessing are not [00:19:00] going to just show people your paper notes or make copies of your paper notes. An EHR can really help with that because you can share them digitally very easily. And again, interoperability. We’re really looking toward sharing records between healthcare providers and having a unified health record and paper notes are not very conducive to that.
So if you’re considering an EHR, I would invite you to check out the review series that’s linked in the show notes. I did a review series of 5 or 6 of the top EHRs at that point, this is two years ago, I think many of them are still relevant, and you can get a better idea of what the EHRs look like and their functionality, especially for testing. I personally recommend TherapyNotes or IntakeQ at this point, but I do plan to review others as they come out. I’ve heard of at least 2 to 3 new EHRs that [00:20:00] are gaining a little steam over the last 6 to 12 months and I’d like to revisit those and do a review through a testing lens.
And if you’re steadfastly against an EHR, I would love to hear why. So write me a note. You can email me at email@example.com and let me know why you are steadfast against an EHR. I want to hear all the arguments.
And on the flip side, if you’re using a stellar EHR that you really love, that really plays well with testing, please write me a note and let me know what it is so I can check it out.
All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out. If you like what [00:21:00] you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcast.
And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development: Beginner, Intermediate, and Advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you.
Thanks so much.[00:22:00] The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.